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Clinical effect of sulbactam/ampicillin on community-acquired
pneumonia with positive Streptococcus pneumoniae urinary antigen test
Niro OKIMOTO, Koichi UCHIDA, Tadashi KATOH, Hisataka TANAKA Toshikiyo HAYASHI, Takeyuki KURIHARA, Naoyuki MIYASHITA Department of General Internal Medicine 1, Kawasaki Hospital, Kawasaki Medical School, 2-1-80, Nakasange, Kitaku, Okayama, 700-8505, Japan ABSTRACT We investigated the efficacy of intravenous penicillin (sulbactam/ampicillin:
SBT/ABPC) in adult patients with positive Streptococcus pneumoniae urinary antigen test
requiring hospitalization. We administered 3g of SBT/ABPC intravenously in the morning and
evening for 7-14 days to 32 adult community-acquired pneumonia patients with positive Binax
NOW® S. pneumoniae urinary antigen. Clinical efficacy, bacteriological efficacy, and side
effects of these patients were prospectively examined. We observed clinical efficacy in a total
of 28 of 32 patients (87.5%); 24 of 26 moderate patients (92.3%), and four of six severe patients
(66.7%). Side effects were drug eruption, increased GOT, increased AMY, and decreased
WBC, observed in one patient each; however, all were mild. SBT/ABPC is extremely useful in
patients with positive S. pneumoniae urinary antigen test requiring hospitalization

Key words： Stereptococcus pneumoniae urinary antigen test, sulbactam/ampicillin
INTRODUCTION
SUBJECTS AND METHODS
　The JRS guidelines for the management of community-acquired pneumonia in adults 　Subjects were 32 patients with adult community- recommend intravenous penicillin drip if acquired pneumonia and positive S. pneumoniae Streptococcus pneumoniae urinary antigen test urinary antigen test who underwent treatment at shows positive. Therefore, we examined the clinical Kawasaki Hospital, Kawasaki Medical School from efficacy of intravenous penicillin (sulbactam/ ampicillin: SBT/ABPC) in patients with adult community-acquired pneumonia and positive 　Adult community-acquired pneumonia patients S. pneumoniae urinary antigen test requiring with positive urinary antigen for S.pneumoniae (Binax NOW® S. pneumoniae) were administered Department of General Internal Medicine 1, Kawasaki Hospital, Kawasaki Medical School, 2-1-80, Nakasange, Kitaku, Okayama, 700-8505, Japan 3g of SBT/ABPC intravenously in the morning and evening for 7-14 days. Then clinical efficacy, bacteriological efficacy, and side effects of these patients were prospectively examined. This study was approved by the clinical trial review committee 　　Chronic obstructive pulmonary disease 　Subjects were 20 males and 12 females aged 40 　Severity by A-DROP system was moderate in 26 　COPD (chronic obstructive pulmonary disease) was observed in four subjects, bronchial asthma in three, bronchiectasis in three, cerebrovascular 　　　　　　　　　　　　　　　　　　　　　　（1）PISP 　　　　　　　　　　　　　　　　　　　　　　（2）PRSP diseases in five, hypertension in five, diabetes mellitus in three, and hypothyroidism in one. 　Clinical efficacy was observed in a total of 28 of 32 (87.5%) patients; 24 of 26 (92.3%) moderate patients, and in four of six (66.7%) severe patients. Efficacy was observed in three patients (PISP two, PRSP one) with penicillin-resistant S. pneumoniae. With regard to sensitivity of penicillin-G , MIC ≦2 μg , MIC ＝4μg , and MIC ≧8μg were judged Bacteriological efficacy (Table 4)　PSSP 19 strains, PISP two strains, and PRSP one DISCUSSION
strain were isolated, and all were eradicated. 　S. pneumoniae is the most frequently observed microorganism in adult community-acquired 　Clinical adverse reaction was drug eruption in pneumonia, accounting for 25-39% of patients with one patient (3.1%). Abnormal laboratory findings pneumonia requiring hospitalization. Pneumonia were increased GOT, increased AMY, and decreased caused by S. pneumoniae is a potentially-severe WBC in one patient each; however, all were mild, and there were no patients whose treatment was 　Gram staining and culture are useful in diagnosis. discontinued, or who received treatment for adverse Recently, S. pneumoniae urinary antigen test has been widely used in the clinical setting for rapid diagnosis. The JRS guidelines for the management of community-acquired pneumonia in adults Okimoto N, et al. : sulbactam/ampicillin on Streptococcus pneumoniae pneumonia recommend S. pneumoniae urinary antigen test to 32 (87.5%) patients; 24 of 26 (92.3%) moderate identify the causative organism. S. pneumoniae patients, and four of six (66.7%) severe patients. urinary antigen test (Binax NOW® S. pneumoniae) Furthermore, in terms of bacteriology, all strains is the method to detect urinary capsule antigen for composed of PSSP (19 strains), PISP (two strains), S. pneumoniae by immunochromatography. It has and PRSP (one strain) were eradicatd.
higher sensitivity than sputum or blood culture, 　Although the MIC of penicillin-G was as high as with a sensitivity of 70-80% and a specificity of 80- 4μｇ10) for PISP and PRSP, administration of 3 g 90%2-5). The JRS guidelines also recommend of SBT/ABPC b. i. d. was efficacious for penicillin- intravenous penicillin for patients with positive S. pneumoniae urinary antigen test requiring 　Side effects were drug eruption, increased GOT, increased AMY, and decreased WBC in one patient 　Therefore, we evaluated the efficacy of each; however, all were mild, showing high safety. intravenous penicillin (sulbactam/ampicillin: SBT/ The results of Metaanalysis11) also showed high ABPC) in patients with positive S. pneumoniae urinary antigen test requiring hospitalization. SBT/ 　As shown above, intravenous penicillin ABPC is ABPC compounded with a β-lactamase (sulbactam/ampicillin: SBT/ABPC) for patients inhibitory agent that exhibits a strong antibacterial with positive S. pneumoniae urinary antigen test requiring hospitalization is extremely useful. 　Subjects were 26 moderate and 6 severe patients aged 40 to 91 years (72.8±15.5years). Many REFERENCES
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